Uncontrolled use of medications can lead to pronounced kidney damage, including acute or chronic renal failure, in the case of substances that are highly nephrotoxic (harmful to the kidneys). Depending on the extent of kidney damage caused by the medications taken, the condition is generally readily treatable if therapy is started early.
What is kidney damage from medications?
Kidney damage caused by medications or as a result of taking medications that damage the kidneys is part of the disease spectrum of toxic nephropathy. Toxic nephropathy refers to chronic or acute damage to the kidneys caused by noxious (disease-causing) substances. Drug-induced kidney damage usually manifests itself in the form of acute kidney inflammation caused by hypersensitivity reactions of the kidneys to the drugs taken, accompanied by allergy-typical symptoms such as joint and limb pain as well as skin rash and fever. In addition, the urine may show a bloody and cloudy discoloration because proteins and red blood cells can no longer be filtered out as a result of the impaired kidney function. As the disease progresses, hypertension (elevated blood pressure), increased urine concentration, edema (water retention) in the legs and arms, pale gray skin, insomnia, cardiac arrhythmias, nervousness, and impaired concentration and bad breath (foeter uremicus) represent additional symptoms of kidney damage from medications.
Causes
Almost all medications possess nephrotoxic properties, especially when taken long-term and/or in high doses. For this reason, blood levels and kidney function are regularly monitored for a variety of medications. Since the kidneys play a decisive role in the detoxification and degradation of pathogenic substances, drugs often place an additional burden on the kidneys, which also have a very high blood supply and are therefore particularly exposed to the substances themselves and their degradation products. If the concentration of the drugs rises above the water reabsorption rate in the blood, there is an increased concentration of these substances in the kidneys, causing the characteristic damage to the kidney tissue. In addition, the breakdown products of certain drugs represent toxic substances that further damage the kidneys. In addition to painkillers, drugs that can cause kidney damage include chemotherapeutic agents, blood pressure regulating substances, diuretics, antibiotics, and rheumatoid and gout medications.
Symptoms, complaints, and signs
Medications can promote a variety of kidney diseases or even cause kidney damage themselves. Possible symptoms of drug-induced kidney dysfunction include fatigue, tiredness, faintness, and a general feeling of illness. Typical physical symptoms are water retention and shortness of breath. Due to the restricted kidney activity, urine excretion is also reduced, which can result in fever and urinary tract infections. Furthermore, cardiovascular complaints such as a drop in blood pressure, palpitations and cardiac arrhythmias may occur. Externally, kidney disease can be recognized by pallor and a generally sickly appearance. Hair loss may also occur. Some affected persons suffer from tremors or even convulsions. The exact symptom picture depends on the triggering drug and the type of kidney damage. What kidney damage has in common is that it greatly reduces the quality of life and well-being of the sufferer. Typically, severe pain and a variety of other symptoms occur, which become more severe as the disease progresses. If the triggering drug is not discontinued, kidney failure eventually occurs and subsequently the patient dies. By switching to a harmless drug, the occurrence of further symptoms can be prevented. Depending on whether permanent damage has already occurred, full recovery may also be possible.
Diagnosis and course
Based on the symptoms currently present, initial indications of kidney damage due to medication can be diagnosed. The diagnosis can be confirmed by blood and urine analysis, which allow statements about kidney function and existing restrictions.If renal damage or restriction of renal function is present, the concentration of urinary substances (creatinine, urea) in the blood and urine is elevated. In addition, further examinations such as quantitative and qualitative functional tests are indicated to determine the extent of renal insufficiency (kidney weakness). Imaging techniques (sonography, computed tomography, magnetic resonance imaging, scintigraphy) can be used to morphologically assess the kidneys as well as the draining urinary tract. In the case of kidney damage caused by drugs, the course and prognosis depend crucially on the extent of the impairment present. Whereas acute renal damage is usually readily treatable by discontinuation of the medication, pronounced renal impairment is often irreversible after long-term use of nephrotoxic drugs.
Complications
Both blood purification and the body’s salt and water balance are disturbed due to the damaged kidney. Various organs thus become limited in their function. As a result, various health-threatening complications may arise despite treatment. Since the body produces less urine, excess water and salts can no longer be adequately excreted. Therefore, blood pressure rises. Due to the reduced urine excretion, the body stores fluid. Edema develops. Primarily, fluid retention occurs in the legs. Edema can occur in all parts of the body. In the worst case, fluid is deposited in the lungs (pulmonary edema). Pulmonary edema manifests itself as white and foamy coughing secretions and can lead to severe shortness of breath. As the cardiovascular system is damaged, pronounced calcifications of the arteries and the heart valves develop. This favors the development of heart valve defects and cardiac insufficiency. The calcified arteries can also cause a heart attack or stroke. As the kidneys increasingly lose their ability to excrete potassium, this can lead to elevated potassium levels in the blood (hyperkalemia). Indicators of elevated potassium levels include a slowed heartbeat, dizziness, brief loss of consciousness, muscle weakness, and tingling sensations. Severely elevated potassium levels can lead to cardiac arrhythmias and cardiac arrest. The excess water associated with high potassium levels can also trigger a stroke or heart attack. Neurological disorders are also common complications. Such disorders of the nervous system manifest themselves as fatigue, impaired memory, concentration, perception and sleep, muscle weakness, itching and disorientation. Due to the weakening kidney function, the body produces only small amounts of blood-forming hormones. Therefore, the development of anemia is favored. This can be manifested by a decrease in physical resilience, fatigue and pallor of the skin. In addition, a decline in kidney function is accompanied by disturbances in bone metabolism. For this reason, bone fractures, bone, muscle and joint pain occur more frequently. The damaged kidney causes the phosphate level in the blood to rise. High phosphate levels trigger itching, bone – and muscle pain. The increased levels also intensify the risk of heart attack and stroke. Additionally, because the body absorbs less protein as kidney function declines, patient malnutrition can result.
When should you go to the doctor?
Kidney damage from medications is always a case for the doctor. The earlier the damage to the kidneys is noticed, the more treatable it is, depending on the type of drug, dose and duration of use. At best, kidney damage caused by medication that is detected early can be completely reversed – but the prerequisite for this is that the affected person seeks medical treatment as soon as possible and does not delay the necessary doctor’s appointment. If the damaging medication is taken on prescription from the doctor, the regular check-ups must be strictly adhered to, as the doctor also checks kidney values here and can notice if damage to the kidneys has occurred. If the patient takes a drug that can damage the kidneys without a doctor’s recommendation, he or she must read the instructions on the package insert before taking the drug and pay attention to possible symptoms of kidney damage while taking the drug.Should these occur, it is advisable to consult a doctor even if they are not perceived as severe or burdensome or if they improve again in phases on their own. Recognize whether they are harmless or really kidney damage from medication has occurred, can only the doctor – so possible symptoms while taking medication should always be taken seriously.
Treatment and therapy
In the case of kidney damage caused by medications, the therapeutic measures depend largely on the extent of the specific damage and on whether the kidneys are affected acutely or chronically. Thus, in the case of acute kidney damage, the first step is often to discontinue the causative drugs. In some cases, hemodialysis is also performed, which temporarily replaces the kidney function until the kidneys return to normal and the excess urinary substances and electrolytes are filtered from the blood of the affected person. Hemodialysis also helps stabilize the circulation and promotes renal perfusion. During therapy, renal function values should be monitored regularly and treatment adjusted accordingly in the event of deterioration. In addition, dietary measures such as a low-salt, low-protein, low-phosphate, and low-potassium diet are recommended to support the treatment of renal damage. Furthermore, the daily amount of fluid should be adjusted to the current performance of the kidneys. If anemia (anemia) is diagnosed, the hormone erythropoietin, which is normally produced in the healthy kidney, is used to stimulate the synthesis of red blood cells in the bone marrow. In a more advanced stage of the disease with irreversible damage to the kidneys as a result of the medication, permanent dialysis or possibly a kidney transplant may be required.
Outlook and prognosis
Kidney damage from medications results in permanent damage to the organ. The tissue is irreparably damaged, triggering impairments in the functional activity of the kidney. Recovery is not achieved in these patients because the self-healing powers of the human organism do not allow regeneration of organic tissues. There is a need for long-term therapy, which involves the administration of medically controlled drugs in order to achieve relief from the health impairments. The goal is to achieve an improvement of the overall situation and to avoid an increase of existing complaints. In some patients, dialysis must be initiated due to the severity of the disease. This is often the only way to reduce existing symptoms. The necessary treatment methods for kidney damage have a strong impact on the organization of everyday life. The physical and emotional burdens are immense for many people due to the necessary therapies. Therefore, there is an increased risk for the development of a secondary disease in these patients as well as a strong minimization of the general well-being. This circumstance must be taken into account when making the overall prognosis. If the kidney damage from the medications taken is severe, there may be a need for a donor organ to avert a possible threat to life. Transplantation is associated with numerous complications that must be considered.
Prevention
The most effective measure to prevent kidney damage from medications is prudent and cautious use of these potentially nephrotoxic substances. Medications that should be used with particular caution include pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs (acetylsalicylic acid), and ibuprofen.
Follow-up
Follow-up examinations and, if necessary, follow-up treatments are necessary for kidney damage caused by medications. Depending on the damage, outpatient follow-up by a nephrologist is advisable. This is also the case when kidney function is largely restored after treatment of the kidney damage has been completed. This limits the risk that can develop as a result of the damage to the kidneys. Appropriate treatment approaches are possible through early detection as part of this follow-up care. Complaints indicating kidney disease or urinary tract disorders are diagnosed promptly.Diagnostic and therapeutic measures can prevent complicated, acute kidney damage if detected early. Annual check-ups are recommended. In this context, the general practitioner carries out examinations on the patient. In addition to determining the urine status, blood count tests are performed. In addition, the patient should see a urologist at least once a year. If normal kidney function is confirmed in the course of follow-up, the intervals between examinations are extended by the attending physician. The follow-up care of the patient includes a generally healthy lifestyle with a balanced diet, with sufficient drinking and sports activities. If the kidney damage caused by medication is very advanced and very severe, temporary or permanent dialysis treatments are also necessary after medical follow-up clarification.
What you can do yourself
People who have suffered kidney damage from medications should seek consultation with their physician for clarification of side effects with any of the prescribed medications. In addition, the package insert should be read carefully. In addition, if there are any questions or uncertainties, the pharmacist can provide missing information. Depending on the existing kidney damage, an individual therapy plan is developed, which the affected person should adhere to. Sufficient fluids should be consumed and heavy physical activities should be avoided. As soon as irregularities are noticed due to overexertion, rest and sparing are necessary. Good and restful night sleep is important for maintaining well-being. Sleep hygiene should be optimized and disturbing factors should be eliminated. Nutrition should be adapted to the needs of the organism. The intake of sufficient vitamins, trace elements and nutrients is necessary to stabilize the immune system. Harmful substances such as nicotine, alcohol or drugs should be avoided as a matter of principle. They worsen the general health condition and can contribute to further impairment of the quality of life. Despite the damage to the kidneys, regular light exercise and spending time outdoors every day are recommended. Yoga or meditation help to build up inner strength and contribute to harmonization of emotional state. Overall, this results in an increase in well-being.